Get Agreement To Provide Consultation - Maine.gov - Maine

This guide is designed to help users complete the Agreement To Provide Consultation form for licensure in Maine. The step-by-step instructions will ensure clarity and support as you fill out the necessary information.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to obtain the Agreement To Provide Consultation form and open it in the designated editor.
2. Begin by entering the name of the consultant in the provided space, ensuring accurate spelling to maintain clarity.
3. Select the appropriate consultation type by checking the corresponding box for either Licensed Social Worker Conditional or Licensed Master Social Worker Conditional Clinical.
4. Fill in the consultant data section with the consulting social worker's name, mailing address, city, state, license number, work telephone number, and type of social work degree.
5. Complete the consultee data section by providing the name of the consultee, their mailing address, city, state, zip code, license number (if applicable), and work telephone number.
6. Provide the applicant’s employment data by entering the place of employment, mailing address, city, state, telephone number, zip code, and the beginning date of employment.
7. Ensure that the agency supervisor's signature is obtained, along with the date, to validate the consultation agreement.
8. Read the affirmation statement carefully. Both the consultant and consultee must sign and date the form to confirm their understanding and acceptance of the consultation conditions.
9. Once all fields are completed, review the information for accuracy. You can save changes, download, print, or share the form as needed.

Complete your Agreement To Provide Consultation form online to ensure a smooth licensure process.